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Invited Commentary
October 2016

Evaluation of the Risk of Postoperative Infection in Adjustable Suture Strabismus Surgery

Author Affiliations
  • 1Department of Ophthalmology, Boston Children’s Hospital, Boston, Massachusetts
  • 2Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
JAMA Ophthalmol. 2016;134(10):1156-1157. doi:10.1001/jamaophthalmol.2016.2943

Adjustable sutures are used in strabismus surgery to protect against undesirable short-term outcomes by allowing the surgeon to fine-tune the postoperative alignment before the extraocular muscle has firmly reattached to the globe. Reasonable evidence is now available that adjustable sutures can enhance surgical success rates by approximately 10%.1 Adjustable sutures have not been adopted universally for many reasons, including the increased logistical complexity of performing the adjustment, uncertainty about the target angle, lack of training, and concerns about complications. One potential complication might be an increased risk of postoperative infection. When conventional adjustable sutures are used, 2 pairs of braided, coated, absorbable sutures remain taped to the periocular skin for 1 to 24 hours after surgery, providing a potential candlewick-like route for bacteria to gain access to the surgical incision. The infection rate after strabismus surgery is, however, extraordinarily low, making it nearly impossible to detect what could be an increased rate of infection that may result from the presence of these sutures. In an attempt to address concerns about possible increased infection rates, some authors have used suture colonization rate as a surrogate for infection risk. In this issue of JAMA Ophthalmology, Rossetto and colleagues2 reported the results of a randomized clinical trial in which they found no significant difference in suture colonization rate in patients treated with adjustable vs nonadjustable sutures regardless of whether povidone-iodine prophylaxis was used.

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